Role model: Making the job fun: the consultant rheumatologist
Authors: Adrian O’Dowd
Journal: BMJ (2022)

<h3>Abstract</h3> <h3>Importance</h3> It is unknown how a lockdown during the COVID-19 pandemic impacts children’s and adolescents’ mental and social health. <h3>Objective</h3> To compare mental and social health of children and adolescents during the COVID-19 lockdown versus before, identify associated factors, describe the change in atmosphere at home and qualitatively assess the impact of COVID-19 regulations on daily life. <h3>Design</h3> Cross-sectional study comparing two Dutch representative samples of children and adolescents (8-18 years); before COVID-19 (Dec2017-July2018) and during the COVID-19 lockdown (April/May 2020). <h3>Setting</h3> Population-based <h3>Participants</h3> Children and adolescents aged 8-18 years (M=13.4, 47.4% male), representative of the Dutch population on key demographics. <h3>Exposure(s)</h3> COVID-19 pandemic lockdown <h3>Main Outcome(s) and Measure(s)</h3> Patient-Reported Outcomes Measurement Information System (PROMIS<sup>®</sup>) domains: Global Health, Peer Relationships, Anxiety, Depressive Symptoms, Anger and Sleep-Related Impairment. Single item on atmosphere at home and open question regarding the impact of the regulations on the child/adolescent’s daily life <h3>Results</h3> Children and adolescents reported significantly worse PROMIS T-scores on all domains (absolute mean difference range, 2.1-7.1; absolute 95% CI range, 1.3-7.9) during the COVID-19 lockdown as compared to before COVID-19. More children reported severe Anxiety (during 16.7% vs. before 8.6%; relative risk 1.95; 95% CI 1.55-2.46) and Sleep-Related Impairment (during 11.5% vs. before 6.1%; relative risk 1.89; 95% CI 1.29-2.78). Fewer children reported poor Global Health (during 1.7 vs. before 4.6%; relative risk 0.36; 95% CI 0.20-0.65). More mental and social health complaints during the COVID-19 lockdown were found in children and adolescents growing up in a single-parent family, having ≥three children in the family, a negative change in work situation of parents due to COVID-19 regulations, and having a relative/friend infected with COVID-19. A small effect was found on atmosphere at home during the lockdown compared to before (mean difference, −3.1; 95% CI, −4.1 −−2.1). A large majority (&gt;90%) reported a negative impact of the COVID-19 regulations on their daily life. <h3>Conclusions and Relevance</h3> This study showed that governmental regulations regarding lockdown pose a serious mental and social health threat on children and adolescents that should be brought to the forefront of political decision making and mental health care policy, intervention and prevention. <h3>Key points</h3> <h3>Question</h3> What is the impact of lockdown during the COVID-19 pandemic on mental and social health in children and adolescents compared to before COVID-19? <h3>Findings</h3> This population-based study shows that during the COVID-19 lockdown children and adolescents report lower mental and social health, especially on anxiety and depressive symptoms. <h3>Meaning</h3> In proposing new COVID regulations (e.g., closing schools) governments should be mindful of the negative impact of a lockdown on mental and social health of children and adolescents.